Rule 122 Content and Form of Proof of Service

(a) Content.—A proof of service shall contain a statement of the date and manner of service and of the names of the persons served.

(b) Form.—Each name and address shall be separately set forth in the form of a mailing address, including applicable zip code, regardless of the actual method of service employed. The proof of service shall also show the telephone number, the party represented, and, where applicable, an e-mail or facsimile address. The name, address and telephone number of the serving party shall be similarly set forth, followed by the attorney’s registration number. A proof of service may be in substantially the following form:

I hereby certify that I am this day serving the foregoing document upon the persons and in the manner indicated below, which service satisfies the requirements of Pa. R.A.P. 121:

Service by first class mail addressed as follows:

Name Telephone number Mailing address (Party represented)

Acceptance of service endorsed by the following:

Name, Telephone number Mailing address (Party represented)

Service in person as follows:

Name, Telephone number Street address Mailing address (if different) (Party represented)

Service by commercial carrier as follows:

Name of commercial carrier Addressee’s name, Telephone number Street address Mailing address (if different) (Party represented)

Service by e-mail at following:

E-mail address, with agreement of: Name, Telephone number Mailing address (Party represented)

Service by facsimile at following:

Fax number with the agreement of: Name, Telephone number Mailing address (Party represented)

Date:

(S) Name, Telephone number (Attorney Registration No. 00000) Mailing address (Party represented)